Reynolds County Health Improvement Plan Narrative

Population

Reynolds County Health Center serves 6,882 residents in 811 square miles. Within these square miles there are over 51,000 acres of land belonging to the Mark Twain National Forest and Missouri Conservation Department. 423 Reynolds County residents live in Bunker, 201 in Centerville, 936 in Ellington, 787 in Lesterville and 4,535 on small farms and acreages throughout the county. As of March 2016, Southeast Hospital of Reynolds County, affiliated with SE Hospital in Cape Girardeau, closed our only critical care access hospital in the county. They also owned the Rural Health Clinic, in Ellington, which was also closed leaving Reynolds County with only one medical provider which is our FQHC.

Unemployment

In March of 2018, the United States unemployment rate was 4.1% and the Missouri state rate was 3.6% compared to Reynolds County with a rate of 3.2%, the highest in the state was Carter Co. at 7.0%, Iron Co. was #4 at 5.7%, Wayne Co was #8 at 5.1%, & Shannon Co was #9 at 5.0%.

Poverty

According to the 2017 US Census Bureau, the median family income in Reynolds County was $36,736 compared to $49,593 for Missouri and all persons living below poverty 22.1 % compared to state rate of 14.1%. In the same profile 2011, our county children living below poverty was 43% compared to state rate of 218%. According to the Missouri Hunger Atlas in 2008, states that 68.6% of children in Reynolds County were enrolled in the free and reduced lunch program, compared to 42.9% statewide. Kids Count Data shows that Reynolds County infants born with low birth weight rate at 9.24% compared to Missouri at 8.06% & births to teenage mothers (Rate per 1,000 females ages 15-17) at 18.21 & Missouri at 15.48. This same profile for our county shows child abuse and neglect (Rate per 1,000 children) at 4.52 compared to state at 4.58, and the US Census Bureau 2010 shows 486 or 18.3% food stamp recipient households compared to state at 13%.

Priority Health Issue and Supporting Data

Following the Community Health Assessment conducted in December 2013, by Southeast Health Hospital of Reynolds County, it was determined that our county’s priority health issue is Mental Health/Substance Abuse (Drug & Alcohol).

The 2017 Status Report on Missouri’s Substance Abuse and Mental Health Problems show that the primary drug problems are Alcohol, Marijuana, & Prescription Misuse. According to the June 2015 Behavioral Health Profile for Reynolds County, created by the Missouri Department of Mental Health, in 2017, Reynolds County had 5 alcohol-related traffic crashes. This number was lower than 2013, which was at 9. One of those 5 traffic crashes resulted in 4 injuries & no with property damage. Also in 2015, Reynolds County had 26 DWI arrests, 22 liquor law violations, & 49 drug arrests. In 2014, Reynolds County residents had a total of 5 alcohol-related and 2 drug-related hospitalizations. 2017, shows 26 in drug court compared to 17 in 2015.

When mental illness data is researched, the 2016 Mental Health Psychiatric Services Report shows there were 32 Mood Disorders, 8 Psychotic, 11 Anxiety Disorders, & 5 Impulse Controls cases treated. 48 cases were voluntary commitments. The 2015 Missouri Student Survey for Reynolds County shows that a new category surveyed on percent of students who have ever used Synthetic Drugs (K2, bath salts, Spice, etc.) went from 0.0% in 2012 to 11.19% in 2016, the average age of students’ first use of Marijuana went from 14 to 13 years old. The percent whose parents would disapprove if they used Marijuana went from 97.6% in 2010 to 94.5% in 2016. In the percent of students who, in the past 12 months, made plans about how they would attempt suicide went from 5.3% to 7.7%. The percent of students who, in the past three months, were victims of an embarrassing or hurtful text message or something posted on the internet jumped from 16.9% in 2010 to 27% in 2016.

Missouri Department of Health & Senior Services MICA Date Program shows that from 2005-2015 there were 7 infant deaths (10.3%) compared to the state rate of 6.85%. An unintentional injury is one that is not inflicted by deliberate means. This category includes those injuries and poisonings described as accidental, regardless of whether the injury was inflicted by oneself or by another person. MICA shows the2016 Death Rate at 675.16 with Missouri at 807.53, ER Visits Rate at 439.76 with Missouri at 375.03, and unintentional injury at 1116.24 with Missouri at 84.77.

In the 2017, Reynolds County Health Questionnaire completed by citizens, the data received is as follows – 34.8% felt their health status was fair to poor while the state rate was 20.1%, 28.5% have no health insurance, 32.7% are physically inactive, 43.4% use some form of tobacco products, 37.2% are overweight (BMI 25-29.9), 36.1% are obese (BMI >30), 45.4% reported High Blood Pressure, 55.9% high cholesterol (35 years or older), 14.8% have diabetes, 90.4% report eating less than five fruits and vegetables a day. These health indicators are tied to lifestyle choices & continued family traditions of eating.

Inventory of public policy, population based strategies, and community physical environment that already exists to support improvement in the priority issue:

After working the past 5 years in county schools, a School Health Index Self-Assessment & Planning Guide for Elementary/Middle/High Schools has been completed. Individual school health committees have been formed & they will develop their Wellness Policy Plans.

Reynolds County Health Center (RCHC) staff will be active participants on the School Health Advisory Boards in local schools.

RCHC will provide through the WIC program with breastfeeding information, supplies & Breast Feeding Peer Counselor supported by the Regional WIC Grant.

RCHC will provide B/P, BS, and Education to the public via Food Pantry Days

RCHC shall have a bulletin board in the health center with Health Education that will focus on the monthly topics identified by the Missouri Hospital Association

MHHC offers health screenings and medication assistance at reduced cost and sliding fee scale to those patients who qualify.

Whole Kids Outreach (WKO) offers summer camp and after school programs to school age children for improved nutrition and increased physical activity. They also are participating in the “Healthy Families of America” Program.

RCHC will offer age appropriate car seats to Reynolds County residents who qualify financially.

RCHC MCH grant staff has formed a Maternal Child and Family Health Coalition to gather community members together to work collectively towards identifying and solving health issues. There will be a Strategic Plan developed with focus areas to address.

Three local schools have added Cross Country to intramural sports and two schools have added track.

RCHC will continue their Facebook Page for the community to promote Health Topics and activities being held.

RC Sheriff’s Department is participating in the “Take Back” Drop Box programs throughout the year to assist citizens to properly dispose of their prescription medications no longer in use or expired.

RCHC will promote use of the county walking trails on their website to increase physical activity as well as a page for tips on seasonal activities to remain active.

Radar Speed Signs are placed in Centerville & Lesterville School areas to slow traffic down to help promote walking and prevent accidents.

RCHC CCHC Program will work with the Summer Reading Program to educate children on Healthy Eating and Activity with “Lana the Iguana” program.

RCHC will work with the Drug Court Program to screen participants for B/P, B/S, Lipid Profiles, Medical History, Imm., BMI, etc. & Education on keeping healthy

RCHC is becoming more Health Literate Aware by revising forms and surveying Health Center for places to become more Health Literate for clients.

Language Link has been contracted for translation services.

Intervention that is planned for implementation:

RCHC will continue to promote the Reynolds County Food Pantries located in Ellington (SEMO Food Bank), Lesterville, and Black (USDA).

RCHC will remain active in Missouri Council for Nutrition and Physical Activity (MOCAN) coalition and keep aware of their progress in policy change for better nutrition and increase physical activity.

RCHC will explore local sites for the feasibility of a Community Treatment Outreach office for counseling services for residents with alcohol and substance abuse issues.

RCHC will continue to offer to loan to local schools education materials dealing with alcohol and substance abuse and driving while under influence of alcohol.

RCHC will continue to partner with agencies, medical schools, and local schools to offer shadowing opportunities to facilitate students considering health and medical careers.

RCHC will continue promotion of the Alcoholic Anonymous meetings in Reynolds County every Tuesday evening at 6:00 PM at the Reynolds County Courthouse in Centerville.

RCHC will continue to participate in the WIC Regional Contract with Region G Collaborative to decrease costs.

RCHC will offer a Breastfeeding Peer Counselor to assist Prenatals in education and support for breastfeeding known to decrease obesity.

RCHC will be redeveloping and updating website to accommodate all technologic devices.

RCHC will maintain marketing strategy of using Facebook Site to followers to announce educational information and awareness campaigns as well as creating an Instagram account

RCHC will continue to refer clients who need assistance with prescription costs to Missouri Highlands to meet their healthcare needs.

Drug Take Back Box will remain in place at RC Sheriff’s Office to assist the community to have a safe place to dispose of unused and outdated prescriptions to decrease access to drug abusers.

RCHC will continue to refer infants in need of Safe Sleep Cribs to programs available.

RCHC will continue the Prenatal High Risk Case Management to all women who meet criteria and choose to participate to be educated on healthy pregnancy and birth outcomes. A “Maternal Substance Abuse Screening” form will be introduced to screening packets.

Pre-conception education will be done on all negative pregnancy tests and for post-partum case management clients

NARCAN will be housed and distributed to Emergency Personnel for use to combat Opioid Overdoses.

NARCAN will be distributed to community citizens for use to combat family members who may be using Opioids. They will be trained on how to administer.

We will participate with Butler County Health Department in the Opioid Quality Improvement Program

Participate in the HRSA Opioid Grant with Missouri Highlands

Target Group/geographic area:

Our target population is the 6,599 residents that live in the 808.48 square miles of Reynolds County.

Outcome the plan is intended to achieve:

Reynolds County residents will have an increased Drug/Alcohol awareness and prevention programs. Reynolds County residents will have increased knowledge of how lifestyle choices directly affect their health and the incidence of chronic disease and in many cases their longevity.

Identified Barriers:

Severe lack of funding in a hurting economy & resistance to change

RCHC small staff

Maintaining commitment and interest levels of community members is difficult.

Reaching county residents with education materials who do not have access to radio, newspaper, and internet is an ongoing challenge.

Public schools are reducing the amount of time available for health education interventions in the classrooms, due to curriculum changes, state requirements and levels of achievements.